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Huang YQ, Weiss S, Gros P, Wong E, Piché PP, Vyas MV, Tam AKH, Watt JA. Prevention and treatment of traumatic brain injury-related delirium: a systematic review. J Neurol 2023; 270:5966-5987. [PMID: 37634162 DOI: 10.1007/s00415-023-11889-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/15/2023] [Accepted: 07/17/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Our systematic review examines the effectiveness and safety of non-pharmacologic and pharmacologic interventions in preventing or treating traumatic brain injury (TBI)-related delirium in acute care. METHODS We searched four electronic databases (MEDLINE, EMBASE, CENTRAL/CDSR, and PsycINFO) to identify randomized controlled trials (RCTs), quasi-experimental, and observational studies. Eligible studies included adults with TBI, at least one comparator group, delirium as an outcome and took place in acute care. Two reviewers independently completed all study screening, data abstraction, and risk of bias assessment using the Cochrane risk of bias 2 tool for RCTs or risk of bias in non-randomized studies-of interventions tool for observational studies. We implemented the PROGRESS-Plus framework to describe social determinants of health (SDoH) reporting. RESULTS We identified 20,022 citations, reviewed 301 in full text, and included eight studies in the descriptive synthesis. The mean age of study participants ranged from 32 to 62 years. 12.5% of included studies reported SDoH. Included studies had moderate-to-high risk of bias. Studies compared reorientation programs and an intervention bundle to usual care, but these interventions were not better than usual care in treating TBI-related delirium. Individual studies found that rosuvastatin and aripiprazole were more efficacious than placebo, and dexmedetomidine was more efficacious than propofol and haloperidol for preventing TBI-related delirium. No studies reported safety as the primary outcome. CONCLUSIONS We identified efficacious pharmacologic interventions for preventing TBI-related delirium, but these studies were at moderate-to-high risk of bias, which limits our confidence in these findings. Future studies should incorporate safety outcomes, and a diverse study population, including older adults.
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Affiliation(s)
- Yu Qing Huang
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, 190 Elizabeth Street, R. Fraser Elliott Building, 3-805, Toronto, ON, M5G 2C4, Canada
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1W8, Canada
| | - Sophie Weiss
- Temerty Faculty of Medicine, University of Toronto, 6 Queen's Park Crescent West, Third Floor, Toronto, ON, M5S 3H2, Canada
| | - Priti Gros
- Division of Neurology, Department of Medicine, University of Toronto, 6th Floor, Stroke and Neurology Clinic, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Edwin Wong
- Temerty Faculty of Medicine, University of Toronto, 6 Queen's Park Crescent West, Third Floor, Toronto, ON, M5S 3H2, Canada
| | - Pierre-Philippe Piché
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada
| | - Manav V Vyas
- Division of Neurology, Department of Medicine, University of Toronto, 6th Floor, Stroke and Neurology Clinic, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Alan Ka Ho Tam
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, ON, M5G 2C4, Canada
| | - Jennifer Ann Watt
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, 190 Elizabeth Street, R. Fraser Elliott Building, 3-805, Toronto, ON, M5G 2C4, Canada.
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1W8, Canada.
- St. Michael's Hospital, 36 Queen St East, Toronto, ON, M5B 1W8, Canada.
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Egerod I, Poulsen I, Langhorn L, Aadal L. Inclusion, delivery, assessment, and outcomes in longitudinal research on sleep disturbance and agitation in TBI-rehabilitation: lessons learned and future considerations. Brain Inj 2021; 35:1616-1623. [PMID: 34550819 DOI: 10.1080/02699052.2021.1978546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE This article presents some issues for consideration before scaling from a pilot study to a larger investigation in longitudinal observational studies of traumatic brain injury (TBI) rehabilitation. MATERIALS AND METHODS We present a case to discuss protocol improvements in longitudinal TBI-rehabilitation studies. The case was a pilot study conducted at two university hospitals in Denmark investigating 1-year outcomes related to sleep disturbance and agitation during neurointensive care. We included patients with moderate and severe TBI determined by the Glasgow Coma Scale, sleep disturbance was assessed using actigraphy, and agitation was assessed using the Agitated Behavior Scale. RESULTS Patients (n = 29) were more severely ill and had poorer six-month outcomes in Eastern vs. Western Denmark. Recovery was similar at one-year follow-up. Protocol improvements were needed in relation to inclusion criteria, intervention delivery, patient assessment, and follow-up outcomes. CONCLUSION In TBI-rehabilitation studies, we suggest adding the severity of disease score to the initial GCS score and a delirium detection score to the ABS score. Actigraphy should not be used during deep sedation. Established procedures should be in place along all stages of the study protocol, including preparation and periodic assessment of study nurses to optimize data quality.
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Affiliation(s)
- Ingrid Egerod
- University of Copenhagen, Rigshospitalet, Department of Intensive Care, Copenhagen, Denmark
| | - Ingrid Poulsen
- Copenhagen University Hospital, Rigshospitalet, Department of Neurorehabilitation, Hvidovre, Denmark
| | - Leanne Langhorn
- Aarhus University Hospital, Department of Anesthesiology and Intensive Care, Aarhus, Denmark
| | - Lena Aadal
- Hammel Neurorehabilitation and Research Center, Hammel, Denmark
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Danielis M, Destrebecq ALL, Terzoni S, Palese A. Nursing care factors influencing patients' outcomes in the intensive care unit: Findings from a rapid review. Int J Nurs Pract 2021; 28:e12962. [PMID: 34002435 PMCID: PMC9286446 DOI: 10.1111/ijn.12962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/17/2021] [Accepted: 04/25/2021] [Indexed: 11/30/2022]
Abstract
Aims To examine the nursing care factors investigated regarding their influence on outcomes of critically ill patients. Background A large number of studies have considered patients' outcomes as sensitive to nursing practice in intensive care unit environments. However, no summary of nursing factors influencing these outcomes has been provided. Design Rapid review, following the seven‐stage process outlined by Tricco and colleagues. Data Sources Articles published up to March 2020 were identified in MEDLINE (via PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scopus databases. Review Methods Eligibility of studies was first assessed at the title and abstracts level. Study inclusion was then established by two researchers by analysing the full texts. Results A total of 93 studies were included, with a total of 21 nursing care factors documented. At the structural level, nursing factors have been investigated at the organizational and at the personnel level. At the process level, nurse‐led programmes, independent nursing interventions and nurse behaviours have been investigated to date. Conclusion The set of nursing factors that emerged can be used in future research to improve poorly developed areas and to accumulate further evidence through additional studies, both at managerial and practice levels. What is already known about this topic?
Thirty‐five nursing‐sensitive outcomes capable of being used to measure the quality of care in the intensive care unit have been identified to date. Several nursing care factors in structural and process dimensions have been documented as having an influence on the outcomes of critically ill patients.
What this paper adds:
Many interventions have been assessed in relation to nursing outcomes, more often at the process than at structural levels. Specifically, a total of 21 nursing factors have been studied to date in the context of intensive care units, divided into structure (organizational and personnel) and process (nurse‐led programmes, independent nursing interventions and behaviours) dimensions.
The implications of this paper
The set of nursing factors that emerged can be considered as a basis for further research, especially regarding poorly developed areas. Emergent nursing care factors can be used as a blueprint to design and develop educational programmes both at under‐ and postgraduate levels. At the managerial levels, both structure and process dimensions of nursing care are capable of affecting outcomes and could be used to inform decision‐making.
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Affiliation(s)
- Matteo Danielis
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,School of Nursing, Department of Medical and Biological Sciences, Udine University, Udine, Italy
| | | | | | - Alvisa Palese
- School of Nursing, Department of Medical and Biological Sciences, Udine University, Udine, Italy
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Hernandez S, Kittelty K, Hodgson CL. Rehabilitating the neurological patient in the ICU: what is important? Curr Opin Crit Care 2021; 27:120-130. [PMID: 33395083 DOI: 10.1097/mcc.0000000000000804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To describe recent literature evaluating the effectiveness of early rehabilitation in neurocritical care patients. RECENT FINDINGS There is a drive for early rehabilitation within the ICU; however, there are unique considerations for the neurocritically ill patient that include hemiplegia, cognitive impairments and impaired conscious state that can complicate rehabilitation. Additionally, neurological complications, such as hemorrhage expansion and cerebral edema can lead to the risk of further neurological damage. It is, therefore, important to consider the effect of exercise and position changes on cerebral hemodynamics in patients with impaired cerebral autoregulation. There is a paucity of evidence to provide recommendations on timing of early rehabilitation postneurological insult. There are also mixed findings on the effectiveness of early mobilization with one large, multicenter RCT demonstrating the potential harm of early and intensive mobilization in stroke patients. Conversely, observational trials have found early rehabilitation to be well tolerated and feasible, reduce hospital length of stay and improve functional outcomes in neurological patients admitted to ICU. SUMMARY Further research is warranted to determine the benefits and harm of early rehabilitation in neurological patients. As current evidence is limited, and given recent findings in stroke studies, careful consideration should be taken when prescribing exercises in neurocritically ill patients.
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Affiliation(s)
- Sabrina Hernandez
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne
- Discipline of Physiotherapy, Department of Allied Health, The Royal Melbourne Hospital
| | - Katherine Kittelty
- Department of Physiotherapy, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Carol L Hodgson
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne
- Department of Physiotherapy, The Alfred Hospital, Melbourne, Victoria, Australia
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Lannin NA, Galea C, Coulter M, Gruen R, Jolliffe L, Ownsworth T, Schmidt J, Unsworth C. Feasibility of modifying the hospital environment to reduce the length of amnesia after traumatic brain injury: a pilot randomized controlled trial. Int J Qual Health Care 2021; 33:6162463. [PMID: 33693639 DOI: 10.1093/intqhc/mzab044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 12/21/2020] [Accepted: 03/08/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Reorientation programmes have been an important component of neurotrauma rehabilitation for adults who suffer from post-traumatic amnesia (PTA) after traumatic brain injury (TBI); however, research testing the efficacy of acute programmes is limited. OBJECTIVE This study aimed to determine if it is feasible to provide a standardized environmental reorientation programme to adults suffering from PTA after TBI in an acute care hospital setting, and whether it is likely to be beneficial. METHODS We conducted a randomized controlled trial with concealed allocation and intention-to-treat analysis. A total of 40 participants suffering from PTA after TBI were included. The control group received usual care; the experimental group received usual care plus a standardized orientation programme inclusive of environmental cues. The primary outcome measure was time to emergence from PTA measured by the Westmead PTA Scale, assessed daily from hospital admission or on regaining consciousness. RESULTS Adherence to the orientation programme was high, and there were no study-related adverse responses to the environmental orientation programme. Although there were no statistically significant between-group differences in time to emergence, the median time to emergence was shorter for those who received the standardized reorientation programme (9.0 (6.4-11.6) versus 13.0 (4.5-21.5) days). Multivariate analysis showed that the Glasgow Coma Scale (GCS) at scene (P = 0.041) and GCS at arrival at hospital (P = 0.0001) were significant factors contributing to the longer length of PTA. CONCLUSION Providing an orientation programme in acute care is feasible for adults suffering from PTA after TBI. A future efficacy trial would require 216 participants to detect a between-group difference of 5 days with an alpha of 0.05 and a power of 80%.
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Affiliation(s)
- Natasha A Lannin
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia.,Occupational Therapy Department, Alfred Health, Melbourne, VIC, Australia
| | - Claire Galea
- Melanoma Institute Australia, Sydney, NSW, Australia
| | - Megan Coulter
- Occupational Therapy Department, Alfred Health, Melbourne, VIC, Australia
| | - Russell Gruen
- College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Laura Jolliffe
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia.,Occupational Therapy Department, Alfred Health, Melbourne, VIC, Australia
| | - Tamara Ownsworth
- Menzies Health Institute Queensland, Griffith University, Mount Gravatt, QLD, Australia
| | - Julia Schmidt
- University of British Columbia, Vancouver, BC, Canada
| | - Carolyn Unsworth
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia.,Federation University, Mount Helen, VIC, Australia
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Poulsen I, Langhorn L, Egerod I, Aadal L. Sleep and agitation during subacute traumatic brain injury rehabilitation: A scoping review. Aust Crit Care 2021; 34:76-82. [DOI: 10.1016/j.aucc.2020.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/17/2020] [Accepted: 05/19/2020] [Indexed: 12/21/2022] Open
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Danielis M, Palese A, Terzoni S, Destrebecq ALL. What nursing sensitive outcomes have been studied to-date among patients cared for in intensive care units? Findings from a scoping review. Int J Nurs Stud 2019; 102:103491. [PMID: 31862529 DOI: 10.1016/j.ijnurstu.2019.103491] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/18/2019] [Accepted: 11/22/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Although many studies have considered mortality and adverse effects as outcomes sensitive to nursing practice, it seems that other outcomes of nursing care in intensive care units have been explored less commonly. OBJECTIVES To describe the state-of-science in research in the field of nursing sensitive outcomes in intensive care units and to synthesize outcomes that have been documented to date as being influenced by nursing care. DESIGN A scoping review study based on the framework proposed by Arksey and O'Malley, further refined by the Levac and Joanna Briggs Institute was performed in 2019. DATA SOURCES The Medline, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Scopus, and Google Scholar electronic databases were searched. In addition, the reference list of included articles was screened. REVIEW METHODS Two researchers independently identified publications on the basis of the following criteria: (a) articles that reported nursing sensitive outcomes on critically-ill adult patients admitted to the intensive care unit, (b) as primary and secondary studies, (c) written in English, and (d) without any time frame limitation. RESULTS Of the 4,231 records, 112 fully met the inclusion criteria and were included. Publications were mainly authored in the US and Canada (n = 44, 39.2%), and the majority (n = 62, 55.3%) had an observational design. A total of 233 nursing sensitive outcomes emerged, categorized in 35 outcomes, with, on average, two per study included. The most often measured outcomes were pressure ulcers (20 studies) and ventilator-associated pneumonias (19 studies); the less studied outcomes were quality of life, secretion clearance, patient-ventilator dysynchrony, and post-extubation dysphagia. When categorizing outcomes, the ones concerning safety (n = 77, 33.1%) were represented the most, followed by those concerning the clinical (n = 72, 30.9%), functional (n = 70, 30.0%), and perceptual (n = 14, 6.0%) domains. The interdependent outcomes linked to multi-professional interventions (e.g., ventilator-associated pneumonias) were the most frequently studied nursing sensitive outcomes (n = 20, 57.1%), while independent outcomes resulting from autonomous interventions performed by nurses were less often studied (n = 8, 22.9%). CONCLUSIONS From a clinical point of view, a large heterogeneity of outcomes influenced by nursing care emerged. However, identified outcomes have been studied with different approaches and metrics, so that future efforts will need to establish homogeneous conceptual and operative definitions. Moreover, increasing efforts in establishing perceptual outcomes, or those close to the fundamentals of nursing care, are suggested in order to better depict the contribution of critical care nurses in the field.
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Affiliation(s)
- Matteo Danielis
- Department of Clinical Sciences and Community Health, University of Milan, Via Vanzetti 5, 20133 Milan, Italy; School of Nursing, Department of Medical Sciences, University of Udine, Udine, Italy.
| | - Alvisa Palese
- School of Nursing, Department of Medical Sciences, University of Udine, Udine, Italy
| | - Stefano Terzoni
- School of Nursing, San Paolo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
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Königs M, Beurskens EA, Snoep L, Scherder EJ, Oosterlaan J. Effects of Timing and Intensity of Neurorehabilitation on Functional Outcome After Traumatic Brain Injury: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil 2018; 99:1149-1159.e1. [DOI: 10.1016/j.apmr.2018.01.013] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 12/23/2017] [Accepted: 01/07/2018] [Indexed: 11/28/2022]
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Trevena-Peters J, McKay A, Ponsford J. Activities of daily living retraining and goal attainment during posttraumatic amnesia. Neuropsychol Rehabil 2018. [DOI: 10.1080/09602011.2018.1441033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Jessica Trevena-Peters
- Monash Institute of Cognitive & Clinical Neurosciences and School of Psychological Sciences, Monash University, Clayton, Australia
- Monash Epworth Rehabilitation Research Centre, Richmond, Australia
| | - Adam McKay
- Monash Institute of Cognitive & Clinical Neurosciences and School of Psychological Sciences, Monash University, Clayton, Australia
- Monash Epworth Rehabilitation Research Centre, Richmond, Australia
- Epworth Healthcare, Richmond, Australia
| | - Jennie Ponsford
- Monash Institute of Cognitive & Clinical Neurosciences and School of Psychological Sciences, Monash University, Clayton, Australia
- Monash Epworth Rehabilitation Research Centre, Richmond, Australia
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Trevena-Peters J, McKay A, Spitz G, Suda R, Renison B, Ponsford J. Efficacy of Activities of Daily Living Retraining During Posttraumatic Amnesia: A Randomized Controlled Trial. Arch Phys Med Rehabil 2018; 99:329-337.e2. [DOI: 10.1016/j.apmr.2017.08.486] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 08/15/2017] [Accepted: 08/23/2017] [Indexed: 10/18/2022]
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